Form SSA-1695-F3, Identifying Information for Possible Direct Payment of Authorized Fees is a form used to collect information in order to facilitate direct payments of an authorized fee. The form - also known as the SSA Form 1695 - was last revised by the Social Security Administration (SSA) in February 2019. An SSA-1695 fillable form is available for download and digital filing below.
If you are an attorney who represents a claimant before the SSA in connection with the claimant's application to the SSA or if you are a non-attorney claimant's representative who meets the requirements, you have a right to request a fee for your services. If you want to receive direct payments from the SSA, you should first receive their approval. Direct payments mean that you receive an appropriate fee not through your client, but directly from your client's past-due benefits paid by the SSA. For this purpose, you need to complete Form SSA-1699, Request for Appointed Representative Services and Direct Payment along with the SSA-1695-F3.
Submit Form SSA-1699 each time you are appointed to represent a claimant. If you did not register when the claim was pending with the SSA, submit this form each time a federal court approves your fee. If you do not provide the SSA with identifying information for a possible direct payment requested via this form or provide it only partially, your payments may be rejected.